Written by Naomi Leppitt, Community Dietitian.
IBS and IBD aren’t the same thing. IBS stands for Irritable Bowel Syndrome. See this/these other post/s for more information on IBS. IBD stands for Inflammatory Bowel Disease and is an umbrella term for Crohn’s Disease and Ulcerative Colitis.
The gut includes the whole process from when you swallow your food, to when you go to the loo. When things go wrong with the gut you can experience: pain, bloating, a rumbling sound you can hear, more wind- or farting – than usual, more difficulty going to the loo (constipation), or going to the loo more often than normal, and it’s loose or liquid (diarrhoea). Sometimes when your body tells you it has to go to the loo, it really has to go right now, and some people experience accidents if they can’t get to a toilet in time. You can also experience poos that come in a range of colours and smells and may not be easy to flush away, or you may notice blood or mucus. If that’s not all bad enough, you can also feel really tired or weak because you’re not taking in all the vitamins and minerals in your food or all the water, so you can get dehydrated.
IBS can be triggered by certain foods, stress and how much or how little you drink. How it shows up can be really bad for some people, or quite mild for others, and it can also vary over time.
IBD, we know less about- it could be triggered by your genes, or your immune system wrongly attacking your own gut, or other things like smoking, drugs, pollution, diet and stress.
IBD is a lifelong, ongoing illness. People can first realise they have it when they’re quite young (15-30 years old) or not until age 60-80. Specific symptoms include mucus or blood in poo and diarrhoea, weight loss, extreme tiredness, pain and cramps in your tummy.
What can make IBD difficult to manage is that it comes and goes for periods of time; this is known as a flare-up and then remission. So you could have a really intense bout and could be hospitalised with it, but then be fine again for months at a time.
Crohn’s Disease is inflammation (red and swollen gut) or ulceration (break in the inside surface of your gut) that can occur anywhere from your mouth to your bottom whereas Ulcerative Colitis specifically effects only your colon- (that’s your large intestine), and your rectum (the very last part of the whole digestion process, holding your poo ‘til you can go to the loo).
IBD has no cure at the moment, but it can be improved by certain medicines which your doctor will recommend. The medicines work by reducing inflammation, but there are side effects to this. Another treatment option includes surgery, by cutting out the parts of your gut that are really damaged.
Dietary Management of IBD during flare-ups:
During a flare up, your body won’t be absorbing nutrients as well, so you may have to intentionally eat a little bit more protein such as beans on toast or eggs for breakfast, or a glass of milk between meals. You might also want to consider a daily multivitamin and mineral supplement, and ask you GP to monitor your blood to check for deficiencies.
There isn’t a recommended diet than can treat the flare-up, but there are diet tips for managing certain symptoms.
Certain foods can make diarrhoea worse: anything high in fibre, caffeine, chocolate and spices. Fruits also contain fructose and some fruits can contain sorbitol, which have a laxative effect too. Some people may find their symptoms improve if they reduce wheat or dairy products.
Here are some tips on eating and drinking if you’re having diarrhoea:
- Eat regularly, and avoid having large meals
- Avoid spicy or fatty foods
- Reduce your fibre during a flare up (fruits and veg, wholegrains, nuts and seeds), and bring it back in once you’re back to normal
- Limit your caffeine to 3 cups per day, or swap to decaf
- Cut down on alcohol and diet fizzy drinks
- Rehydrate with a Rehydration Treatment eg dioralyte, electrolyte to make sure you replace the sugars, salts and water you lose when you’re having diarrhoea
- If you notice dairy in particular is effecting you, swap to lactose-free products during a flare up, (as it could be that you’ve developed a temporary intolerance to the lactose in dairy products)
- Probiotics like VSL#3 may have a benefit on symptoms in Ulcerative Collitis, but there’s less evidence for the benefits of probiotics in Crohn’s
- Get advice from a dietitian if you’re thinking about making major changes to your diet, as you don’t want to miss out on important nutrients.
If you have a stoma, speak to your stoma nurse if you’re having diarrhoea, known as ‘high-stoma-output’, as they may recommend medicines like loperamide. You could also try to have more carbohydrates to bulk out your stoma-output.
This website also provides helpful hints and tips on other lifestyle aspects of managing IBD, including getting access to public toilets, and how to help with sore skin on your bottom.
For other people they mostly experience constipation, and may also feel bloated or sick.
As well as medications and regular exercise, here are some tips on eating and drinking if you’re having constipation:
- Drink more! Aim for 8 glasses a day, (but avoid caffeine and alcohol),
- Increase your fibre: You could have some fruit with breakfast, salad in your sandwich, or switch to whole-wheat bread, keep the skins on your vegetables or potatoes – (however, if you have a stricture, this is not advised, so speak to a dietitian or your IBD team).
Diet During IBD Remission
Even though you may feel back to normal when you’re not having a flare-up, it’s important to have a healthy balanced diet, as if you don’t have enough energy, protein, fibre, vitamins and minerals in your diet, it could make your rate of recovery slower, and make you more likely to be hospitalised during a flare up.
Something to consider if you’re in remission from IBD, but experiencing: diarrhoea, bloating, wind, pain or feeling sick or tired, then a Low FODMAP diet is shown to improve symptoms for most people. This is a complex diet which requires time and effort, but if it helps then it’s worth it. Always see a dietitian for help with a low FODMAP diet.
Abegunde AT et al. Environmental risk factors for inflammatory bowel diseases: Evidence based literature review. World J Gastroenterol. 2016;22(27):6296-6317. doi:10.3748/wjg.v22.i27.6296
Forbes et al. ESPEN Guideline: Clinical nutrition in inflammatory bowel disease. Clinical Nutrition 36 (2017) 321-347. Available online at: https://www.espen.org/files/ESPEN-guideline_Clinical-nutrition-in-inflammatory-bowel-disease.pdf [Accessed 1 July 2020]
Prince et al 2016 Fermentable Carbohydrate Restriction (Low FODMAP Diet) in Clinical Practice Improves Functional Gastrointestinal Symptoms in Patients with Inflammatory Bowel Disease, Inflammatory Bowel Diseases, Volume 22, Issue 5, 1 May 2016, Pages 1129–1136, https://academic.oup.com/ibdjournal/article/22/5/1129/4561787